Sexuality and Sex Life in Cancer

A cancer diagnosis for you or your partner can trigger an emotionally intense period. "The Moment Time Stands Still: A Cancer Diagnosis" is our article discussing in detail the bombardment of emotions you may experience, including shock, denial, anger, anxiety and depressed mood.

Almost every couple experiences greater-than-usual stress during this period for various reasons. Coping with intense, complex emotions, adapting to changing roles, making decisions, deciding what and how much to share with children and others, and reorganizing work and finances can involve disagreements and misunderstandings. But one important topic is often overlooked during this complex period: sexuality and sex life!

This article offers suggestions on difficulties and solutions concerning sexuality and sex life, often negatively affected by cancer and treatment.

Sexuality and Sex Life

Sexuality encompasses the thoughts, feelings and behaviors forming your sexual identity.

It is a highly personal area closely linked to who you are and how you feel as an individual, perceived and experienced differently by different people.

Sexual attitudes and behaviors vary greatly, shaped by experience, upbringing, genetics, cultural and religious beliefs, and hormones. They can change with circumstances and be experienced differently at different times in life.

Each person is unique in thoughts, feelings and behaviors, and sexual identity and sexuality are part of who you are. Although your sex is fixed, sexuality can change. Your thoughts may change, you may enjoy new things and communicate in new ways.

Sex Life After Cancer

Cancer does not take away sexuality as part of your identity. After diagnosis and treatment, you can still feel good about who you are and how you express sexuality and have a satisfying sex life.

Predicting how cancer and treatment will affect you is difficult. A treatment-focused mind after diagnosis and possible adverse effects may make sex less of a priority. Some stop sexual activity fearing harm to treatment or transmission to a partner. Yet sexual activity is known not to affect cancer treatment. For many, these changes are temporary. Sometimes you must adapt to permanent changes and discover new ways to give and receive pleasure. Open communication and support always make enjoying a satisfying sex life possible.

Four Main Ways Cancer or Treatment Can Affect Sexuality:

1. Physical/Structural Problems Affecting Giving and Receiving Sexual Pleasure

• Surgical changes to genital structure or damage to nerves or blood vessels
• Treatments affecting sex hormones
• Radiotherapy and surgery in the pelvic (groin) area
• Pain, fatigue, nausea, etc.

2. Functional Problems Through Thoughts and Feelings About Appearance and Body Image

• Concerns about losing attractiveness or being undesirable
• Inhibition from concerns about infertility

3. Functional Problems Caused by Inhibiting Emotions Such as Fear, Anger, Grief, Anxiety and Depressed Mood

• Fear that sexual activity could harm treatment or spread cancer to a partner (unfounded)
• Anxiety about pain during intercourse

4. Problems From Possible Relationship Difficulties and Role Changes With Your Partner

These areas are linked: a problem in one may affect another.

Cancer may affect sexual feelings about yourself or your physical ability to give and receive pleasure.

Many people feel, because of cancer or treatment, exhausted and say they have almost no energy for months or years. This prolonged fatigue may cause loss of sexual interest during and after treatment.

Emotions, Sexuality and Cancer

Emotions can strongly affect sexuality and sexual behavior. Depression or anxiety may make desire and arousal difficult. Worry about cancer, treatment or the relationship may also affect attitudes toward sex and intimacy.

Diagnosis often triggers powerful emotions reducing sexual interest. Fear, anxiety, pain, anger, jealousy and sometimes envy can obstruct arousal.

People with cancer- or treatment-related body changes may feel unattractive and avoid sexuality from fear of rejection. Ordinary daily emotions can also become so intense that there is no strength to think about or desire sex, appearing outwardly as low sexual desire.

Conversely, some experience increased arousal. Others feel guilty about sexual concerns, believing they should be grateful to be alive and should not consider sexual problems in these circumstances. These feelings can be overwhelming and draining.

Ways to Express Feelings

Sexual confidence often directly relates to overall well-being. If cancer has damaged self-confidence, sexual confidence may also suffer. Talking about and expressing these difficult feelings helps the process

Sharing your feelings with someone who listens without judgment and sometimes offers guidance can help — perhaps family or a close friend, or someone unfamiliar but professionally qualified….

If you have a partner, openly discussing worries about sex and cancer may overcome communication problems. It is often difficult for them too, but communicating and expressing feelings without blaming yourself or others helps far more than long silences.

Your healthcare team may suggest sex therapy. Sex therapists specialize in intimacy and relationships and provide advice and practical help under strict confidentiality. They can help express anger and other feelings. After years avoiding sensitive subjects, many couples use initial appointments to become more open and honest. Open discussion with your partner helps overcome common sexuality and cancer problems.

Sexual contact and intercourse can sometimes begin the solution. After sex, anger and other intense, draining emotions may ease. Sexuality may also distract from upsetting feelings.

Changing Relationship Roles and Sexuality

As noted, cancer or treatment can affect current and future relationships and therefore sexuality.

Your family role may change. Treatment can leave you more tired and temporarily unable to be the breadwinner. If this makes you feel inadequate or dependent, sexual confidence may decrease and affect your sex life.

Your partner relationship may change too. After a break, both may worry about resuming sex. Desire may have changed since treatment. Being open about feelings and wishes makes solutions easier.

New relationships may also be difficult. You may not know when or how much to share feelings, thoughts and concerns with a new partner. Sharing worries with family or friends, or seeking professional support, may help.

Similar role changes can affect friendships. Some friends adapt to cancer's changes and intense emotions; others cannot cope and quietly withdraw, breaking communication. This may feel like abandonment or rejection, but cancer also affects others' lives and can be very difficult for them. Focus on friends who can listen and support you.

During treatment or after surgery, you may lack energy for your usual household tasks. Relatives, friends and neighbors may become more involved to help, but sometimes this makes you feel "I'm no longer useful", "I've lost control of my life" as emotions. You may feel you have lost your place. Fulfilling a mother, father or partner role forms part of sexual confidence, so changes are hard to handle and may directly affect sex life.

Cancer and treatment may change future plans. Whether single or partnered, you have many plans for relationships and sexuality. Some look forward to children leaving home to gain personal time, strengthen intimacy or travel. Sudden cancer upends plans, and grieving these less visible but important losses is normal.

What Can Help Sex Life During Cancer?

1. With your partner, being open, expressing feelings, thoughts and needs, and trying to discuss fears and worries are important first steps. Remember they may be experiencing an equally complex process. A nonjudgmental, nonblaming conversation sharing likes and dislikes rather than expecting them to guess increases emotional closeness. They too may avoid intimacy for fear of hurting you.
2. Believing you cannot adequately meet your partner's sexual needs may cause fear of losing them as a concern. Discussing these matters may be harder in conservative societies like ours, where sex is difficult to discuss. But sharing fears and sexual concerns helps both feel more comfortable together.
3. Being open to changeencourages healthy sexuality. You may need new openness and flexibility. If you were always the active partner, that may temporarily change. Favorite positions may become uncomfortable temporarily or permanently. You may begin to view sex as only intercourse. Sometimes physical reasons rule intercourse out; then you can discover other ways to give and receive pleasure.
4. Within busy lives, find opportunities with your partner to enjoy yourselves and invest emotionally in each other; try to make time, necessary for restoring balance and normality to the relationship.
5. If body image worries remain difficult, change surroundings or conditions to feel more comfortable. Dimming lights, staying partly clothed during sex or emphasizing body areas you like can still provide a satisfying experience.
6. Sex is a normal part of life. If you need help with sexual problems, seek professionals with structured training in this field, sufficient experience and professional supervision, through support from mental health professionals as we recommend. Training does not mean short certificate events claiming to teach sex therapy in a few days. Reliable institutions in our country, notably CETAD (Association for Sexual Education, Treatment and Research) and CİSED (Sexual Health Institute Association), provide this training. Their websites list trained practitioners in Türkiye, allowing patients to find therapists by province. Medicines for sexual dysfunction are also available.

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